LIFE INSURANCE: CORPORATION OF INDIA Pact Tt NATIONAL ELECTRONIC FUNDS TRANSFER - MANDATE FORM indore s 70 LIFE INSURANCE CORPORATION OF INDIA Branch ‘Sub : Receipt of policy payment through NEFT am giving below the details of my Bank account for receiving policy payment through NEFT (1). Policy No/s ° (slglé Tala ist : DEE] Name of policy holder / claimant : Btmal Ku. Das 2) BankName: State Rane India (3) Bank Brahch Address : i 2 (4) Account Type : Savings / Current / Cash Gredit /NRI Sayed (8) AccountNo. Bile ee eee gg (6) IFS Code: PIFINTS To OIUI2 TTS) ~~ (7) Mobile number: sia he +l [So IS 161916 TL14] (8) E-mailld: - oldies * (9) Are you willing to receive SMS/E-maill, on matters related to your LIC | 2 a3 Sqpogere pao © have enclosed the following document to this ettect (Please V appropriate item) A. Cancelled cheque leaf co B. cheque is nothaving the name ofbankholderthenPhotocopyofthe. ay page of Bank pass book containing detalls of Bank accounts number, [FS code : Signature of the policy holder 9. Date: OM (E-D0IE™ ((n case of change in Bank details, jahdate form again and Submitthe sanie to Our Branch Office “If your answer to Q no 9 is “Yes"), then we will be able to send you am je when LIC transfers money to you ‘Account through NEFT This message will contain’the UTR (Unique Transaction Referenca}number which can be used to make any enquiry regarding the payment. i ; ob